Sarasota Cardiac & Thoracic Surgery

Valve Surgery

Valvular heart disease comprises a significant portion of heart disease, with a variety of sites (the four valves) and an array of symptoms. A large percentage of valvular disease is a result of rheumatic disease - a febrile illness that follows a streptococcal infection. Some valve disease is due to a benign overgrowth of tissue or to an accumulation of calcium deposits, and other valve dysfunction is due to congenital anomalies.

Once an abnormality is identified either due to symptoms (shortness of breath, swelling, lightheadedness, or chest pain), a murmur, and/or an echocardiogram, surgical correction is often recommended.

Valve Repair PDF - Click Here to Print

Dysfunctional cardiac valves do not always need replacement. Valves have leaflets or cusps. When they do not make proper contact with each other, regurgitation (or leakage) can occur. If the valve remains flexible it can often be repaired.

A repair is done by removing a small section of valve tissue and sewing the remainder of repaired leaflet back together. A ring is then sewn to the base of the valve to "stiffen" its shape. Occasionally, the problem with the valve is the tendinous cords that anchor it, or the small muscles to which those cords attach. In some cases, your surgeon can repair those specific cords or muscles. Valve repair has traditionally been most successful with the mitral and tricuspid valves. The determination of whether or not your valve can be repaired is made during your surgery, when your surgeon can clearly see your anatomy and evaluate the cause and extent of the problem.

Valve Replacement-mechanical/tissue

For those valves that cannot be repaired, replacement is an option. The processes that cause some valves to fail include the collection of calcium deposits that make the valve stiff or inflexible, infection, or tissue overgrowth called myxomatous changes.Replacement heart valves are of two general types: mechanical or tissue.

Mechanical valves are constructed of a combination of metals and plastics and come from a variety of manufactures. See Links. Tissue valves originate from either a pig or cow and are chemically treated and prepared for human use. Each type of valve has specific advantages and disadvantages. The decision on the type of valve used should be made in conjunction with your surgeon and your cardiologist. Ultimately, the choice will depend on a patient's preferences, lifestyle, and individual risks as determined by age and other medical conditions.

Mechanical Valve

A mechanical valve is carefully designed to mimic the native heart valve. Like your own heart valve, the mechanical valve opens and closes with each heartbeat, permitting proper blood flow through the heart. The major advantage to this valve is that it has an indefinite lifespan. The drawback is that to prevent any blood clots from developing on the valve, which can cause complications, a mechanical valve replacement requires you to take lifelong anticoagulation medicine (Coumadin). Coumadin is a safe medication when monitored regularly (at least once a month). See Links. But, there remains a small but definite risk of blood clots causing stroke, even when taking anticoagulants.

Tissue Valve

The major advantage to a tissue valve is that lifelong anticoagulation (Coumadin) is not necessary. The limitation of this valve remains with their durability. How long they will last depends on the patient and their age. The design of tissue valves continues to evolve. Some tissue valves have a frame, or stent, that supports the valve, and some valves are stentless (no framework). A very thin polyester mesh cuff is sewn around the outside of the valve for easier implantation. Eliminating the stent makes it possible for the surgeon to implant a larger valve. Larger valves generally provide more surface area for blood flow; this allows more blood to flow through the valve to accommodate the body's needs. The general consensus is that a tissue valve will not need to be replaced if used in a patient over the age of 70 years, and this age continues to be reduced.

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